Lee Soo Youn, Shim Chi Young, Hong Geu-Ru, Cho In Jeong, Chang Hyuk-Jae, Ha Jong-Won, Chung Namsik
Department of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
PLoS One. 2017 Jan 6;12(1):e0169285. doi: 10.1371/journal.pone.0169285. eCollection 2017.
We aimed to identify the clinical and echocardiographic determinants of symptoms and their prognostic implications in patients with moderately dysfunctional bicuspid aortic valves (BAVs).
Among 1,019 subjects in the BAV registry treated in a single tertiary care center, the records of 127 patients (85 men, age 58±13 years) with moderately dysfunctional BAVs were comprehensively reviewed. The patients were divided into two groups based on symptom status: asymptomatic (n = 80) vs. symptomatic (n = 47). The primary end-point was defined as a composite of aortic valve surgery, hospitalization for heart failure, and any cause of death.
The symptomatic group had a higher proportion of females, hypertension, aortic stenosis, and aortopathy than did the asymptomatic group. The symptomatic group showed lower e' (5.5±1.7 vs. 6.5±2.2 cm/s, p = 0.003), higher E/e' (13.3 ± 4.9 vs. 10.9±3.7, p = 0.002), and larger left atrial volume index (29.9±11.4 vs. 24.6±9.1 ml/m2, p = 0.006) than did the asymptomatic group. In multivariate logistic regression analysis, female gender (odds ratio [OR] 2.84, 95% confidence interval [CI] 1.10-7.36, p = 0.031), hypertension (OR 3.07, 95% CI 1.20-7.82, p = 0.019), moderate aortic stenosis (OR 5.33 5.78, 95% CI 1.99-16.83, p = 0.001), E/e' >15 (OR 3.82, 95% CI 1.03-11.19, p = 0.015), and aortopathy (OR 2.76, 95% CI 1.07-7.10, p = 0.035) were independently correlated with symptom status. The symptomatic group showed a significantly lower rate of event-free survival during the 8-year follow-up period (54±9% vs. 68±10%, p = 0.001).
In patients with moderately dysfunctional BAVs, the presence of moderate aortic stenosis, aortopathy, and diastolic dysfunction determines symptom status, along with female gender and hypertension. Symptom status was associated with clinical outcomes.
我们旨在确定中度功能障碍的二叶式主动脉瓣（BAV）患者症状的临床和超声心动图决定因素及其预后意义。
在单一三级医疗中心接受治疗的BAV注册登记的1019名受试者中，对127例中度功能障碍的BAV患者（85名男性，年龄58±13岁）的记录进行了全面回顾。根据症状状态将患者分为两组：无症状组（n = 80）与有症状组（n = 47）。主要终点定义为主动脉瓣手术、因心力衰竭住院和任何死因的综合结果。
有症状组女性、高血压、主动脉瓣狭窄和主动脉病变的比例高于无症状组。有症状组的e'较低（5.5±1.7 vs. 6.5±2.2 cm/s，p = 0.003），E/e'较高（13.3 ± 4.9 vs. 10.9±3.7，p = 0.002），左心房容积指数较大（29.9±11.4 vs. 24.6±9.1 ml/m2，p = 0.006）。在多因素逻辑回归分析中，女性（优势比[OR] 2.84，95%置信区间[CI] 1.10 - 7.36，p = 0.031）、高血压（OR 3.07，95% CI 1.20 - 7.82，p = 0.019）、中度主动脉瓣狭窄（OR 5.33 5.78，95% CI 1.99 - 16.83，p = 0.001）、E/e' >15（OR 3.82，95% CI 1.03 - 11.19，p = 0.015）和主动脉病变（OR 2.76，95% CI 1.07 - 7.10，p = 0.035）与症状状态独立相关。在8年随访期内，有症状组的无事件生存率显著较低（54±9% vs. 68±10%，p = 0.001）。
在中度功能障碍的BAV患者中，中度主动脉瓣狭窄、主动脉病变和舒张功能障碍的存在以及女性性别和高血压决定了症状状态。症状状态与临床结局相关。
